New kinds of care, new kinds of relationships: how purchasing services affects relationships in giving and receiving personal assistance

This paper draws on interviews with users of direct payments and focus grou p discussions with the personal assistants (PAs) who assist them with perso nal and daily living activities. It discusses the benefits and the drawback s of directly employing such assistance, from the perspectives of both the purchasers and the providers of these services. The paper shows that direct payments can enable disabled people to purchase a much wider range of flex ible help, better continuity, greater control and an enhanced quality of li fe, compared with conventional services. PAs also valued the trust and clos e relationships they developed with their employers. However, these benefit s were much less marked when direct payment users recruited and employed pe rsonal assistants through care agencies. On the other hand, both direct pay ment users and PAs also sometimes experienced difficulties in managing the relationships between them. Some of these problems could be alleviated by c hanges in the support provided by direct payment schemes themselves; other difficulties were more intractable and arose from the nature of the work an d the close relationships which it entailed. The paper recommends a number of measures which could reduce the risks and vulnerability of both disabled direct payment users and personal assistants, without reducing the enhance d quality of life which direct payments can confer.